Augmented Reality-Based Training for a Rapid Blood Transfusion Device Among Emergency Nurses: Randomized Controlled Trial.

Background: Emergency nurses must be proficient in operating the Level-1 rapid infusion system to manage hypovolemic shock effectively. However, training opportunities for this infrequently used but life-critical device remain scarce, owing to resource constraints and limited access to equipment. Augmented reality (AR) has emerged as a promising educational technology that provides immersive, hands-on learning experiences without compromising patient safety; yet its application to specialized medical device training in nursing has not been rigorously evaluated. Objective: This study aimed to evaluate the effects of an AR-based training program using Microsoft HoloLens 2 on emergency nurses' clinical competency, self-efficacy, and educational satisfaction in operating the Level-1 rapid infusion system, compared with traditional guideline-based self-directed learning. Methods: A posttest-only randomized controlled trial was conducted at Samsung Medical Center in Seoul, Republic of Korea. Between July 17 and July 20, 2023, 42 registered nurses with no prior Level-1 experience were enrolled and randomly assigned in a 1:1 ratio to an experimental group receiving AR-based training on a single HoloLens 2 device (n=21) or a control group performing self-directed learning from a printed manual (n=21). Clinical competency was assessed by time (learning and performance), accuracy (a manufacturer-aligned checklist scored out of 100, and an expert-validated 22-step pass or fail evaluation), and the number of assistance requests. Self-efficacy (6-item scale; Cronbach α=0.80) and educational satisfaction (4-item scale; Cronbach α=0.87) were measured by questionnaire. Because most outcomes were non-normally distributed, groups were compared using the Mann-Whitney U test, with data reported as medians and IQRs. Results: Learning time was longer in the experimental group (median 18.20, IQR 15.48-21.67 vs 8.98, IQR 5.85-11.68 min; P<.001), but device setup time was markedly shorter (3.67, IQR 2.90-4.63 vs 9.85, IQR 8.03-11.35 min; P<.001). The experimental group achieved higher median device operation competency scores (90.00, IQR 80.00-100.00 vs 70.00, IQR 50.00-75.00 of 100; P<.001), passed more of the 22 evaluation steps (20.00, IQR 20.00-22.00 vs 16.00, IQR 13.00-18.00; P<.001), and required fewer assistance requests (0.00, IQR 0.00-1.00 vs 2.00, IQR 2.00-3.00; P<.001). Self-efficacy (20.00, IQR 18.00-25.00 vs 16.50, IQR 13.00-20.00; P=.003) and educational satisfaction (18.00, IQR 16.00-18.00 vs 12.00, IQR 9.75-15.00; P<.001) were also significantly higher in the experimental group. Effect sizes for the principal competency outcomes were large (Cohen d=1.2-3.1). Conclusions: AR-based training significantly improved emergency nurses' clinical competency, self-efficacy, and educational satisfaction in operating the Level-1 rapid infusion system compared with traditional self-directed learning. Despite requiring longer initial learning time, AR training produced faster device setup, greater accuracy, and enhanced learner independence. These findings suggest that AR technology can serve as an effective and scalable training solution for infrequently used but critically important medical devices in emergency care settings.